by Melanie Zarabi
From the day I first met Frankie, I was drawn to him like a moth drawn to a flame. He stood out at the VA by his unusual appearance, dressed in a paint-splashed over-shirt, jeans and sneakers and not in the usual military garb typically worn by Vietnam War veterans. I saw him as the liveliest and deadliest member of the group, and most consistently unpredictable. Although he was short and stocky, he filled the room with his loud voice and hearty laugh. He had a full head of thick silver hair down to his shoulders that bounced around with the rest of his exaggerated gestures which enhanced his tan rugged face, intense dark eyes, bushy silver eyebrows, and thick silver mustache.
We made positive contact through our mutual interest in art and creativity. I was compelled to work with him initially because of his immense desire to drink in as much treatment as possible. He enthusiastically engaged himself in the voluntary psychosocial program that I direct, including my art and psychotherapy groups.
Frankie was referred to the program in March 2006, as part of the discharge plan that concluded an intensive stay in a VA day hospital program (July 2005 – March 2006), where he was diagnosed with Post-traumatic Stress Disorder. He began attending my program in July 2006 and started once weekly individual therapy with me in September 2006, which was increased to twice weekly individual therapy from January 2008 – April 2009.
Prior to the Day Hospital program, Frankie had been hospitalized on a VA inpatient psychiatric unit (June 2005 – July 2005), where he was treated for a severe vegetative depression with suicidal ideation and diagnosed with “Major Depression”. He had attempted suicide five years earlier (April 2003) by trying to suffocate himself by placing a plastic bag over his head, but did not go through with it. He removed the bag when he could no longer breathe. After he caught his breath he took himself to the nearest VA Emergency Room. After being evaluated, he walked out of the ER and did not follow up with recommended psychiatric care. Until his suicide attempt, he had not sought out any medical or dental care since he left Vietnam. After he was hospitalized he realized the seriousness of his depression and embraced all the psychiatric, medical, and dental treatment that was available to him.
Cast of Characters and Symbols:
Frankie: Adult patient
Frankie the Bull: Imago/shadow aspect of patient as an adult bully character
Annihilating Black Square of Thanatos: Patient’s death instinct
Lucy: Lucille Ball character in “I Love Lucy” TV show
Psychoanalytic Matador: Analyst as “I Love Lucy” TV character
Italian Bull: Patient’s mother
Bull Breast: Representation of Frankie’s first part-object & object relation
Frankie the Bull-et: Patient as an infant
Ferdinand the Bull: Story book character as child & libidinal self
Good Looking Horse: Patient’s ex-wife
Rooster: Patient’s first representation for new girlfriend
Cow: Patient’s second representation for new girlfriend
Oscar-Patient’s adopted male kitten/replacement for son
Lucy Kitten: Patient’s adopted kitten/replacement object for analyst
Bull Ring: Analyst’s office
Bad Breast Collage: Symbolic image of condensed and merged self & object representations
“Annihilating Black Square of Thanatos Mural”
Two years after his abrupt termination from his analysis (April 2009) Frankie re-appeared in the program and executed a very large (168” x 50”) abstract mural for the patient lounge bulletin board. As I contemplated the mural, it appeared to capture who he is symbolically. At its center was a large black square, surrounded by brilliant colors. I perceived the black square as the “Annihilating Black Square of Thanatos” – a symbol of Frankie’s powerful death instinct in the depths of his being.
“Bad Breast Collage”
Several days later he reappeared in my art therapy group with his humble and compliant self, and created a little (5’’ x 5”) square collage, which I refer to as the “Bad Breast Collage”. I view it as a symbol for his condensed and merged self and object representations. When I looked at his immense mural in juxtaposition with his tiny collage, it appeared to me that a process of “reversal” had occurred. In contrast to the large black square at the center of his mural, there was a modulated burnt orange, decaying breast-like form surrounded by a ring of brown (fecal) patches at the center of his collage. The brilliant multi-colored ground of the mural had been replaced by the brilliant yellow ground with patches of red (aggression and anger). I view the luminous colored grounds of both images as symbolizing his idealized self representation. The large black square (condensed annihilating self and object representations) at the center of the mural appeared to reverse and is transformed into the decaying, fecalized, burnt-out Bad Breast (condensed self and object representations) at the center of his tiny collage. The large black square at the center of the mural appeared to have fragmented, diminished, and almost disappeared; and was replaced by the breast-like form. It seemed to re-appear and transform itself into the little dark blue corners of his tiny collage. My contemplation and analysis of the symbolism found in the content and juxtaposition of these two artworks demonstrated to me, just how volatile and unstable Frankie’s self and object representations are; and how quickly they shift into each other’s opposite in such extreme ways. It appeared to me that they even condensed and collapsed into each other. As Eigen (1993) writes:
Freud suggested that the operation of reversal is so basic that it seems to antedate the development of usual defenses. He gave, as an example, the tendency of an impulse directed toward another object to turn upon the self (and vice versa). It would appear that a double-headed arrow joins self and other. However, not only may an impulse shift directions, it may also change in valence as well, as when an impulse turns into its opposite (love-hate). As defenses develop, they exploit the minds capacity to reverse directions and change valence. Typical styles of reversing areas of experience develop and gradually become part of one’s character. In psychosis, the capacity to reverse spirals and hardens. Reversal tends to become a steady state, which turns any experience into what it is not. The Individual may so place himself on one side of duality that the excluded opposite assumes demonic proportions. The capacity to reverse may accelerate to the point at which the individual spins himself out of existence, or decelerate until what remains of existence falls in upon itself. At the same time, this capacity helps build our sense of self and other and contributes to our creative life. (p. 35)
Before we processed Frankie’s collage in the art therapy group and prior to my contemplation and analysis of the two images, I had imagined that his little collage might be a symbolic representation of his libidinal self. My reverie about his returning to the program and his creation of the mural; and his joining my art therapy group and creating the collage, was that they served as transitional experiences for him to reconnect with me. This represents just how strong my countertransference need was to see and find his libidinal self. But he looked at his collage and exclaimed, “I can’t get enough sex and money”. I thought of this as an expression of his free-floating greed which seemed to come from nowhere.
After the art therapy group session, Frankie and I were standing in front of his large abstract mural and I asked him, “So, what is in that Black Square”?” He glanced at it and it and said, “Hell if I know!” Frankie resists acknowledging symbolic process, yet his language expressed the hell it represented, even if he could not acknowledge it. Frankie had crafted a colorful personality from early childhood as camouflage to divert attention away from his “dark side” and to keep others engaged only with the surface presentation of himself. The brilliant multi-colored ground which the large black square appears to float in, appeared to symbolize this aspect of his personality.
Frankie presents himself as bigger than he is, and I experienced him as enormous. Compared to him I see myself as rather fearful, and I admired and envied his apparent fearlessness. What initially appeared to me as a luminous and libidinal center of the little collage began to appear as a decaying process at the core – a kind of fecalization of both self and object.
I relied heavily on my intuition and my many years of experience of working with traumatized war veterans until I developed greater confidence in my newly acquired psychoanalytic skills and technique. We enjoyed laughing together as he charmed and seduced me with his entertaining stories and witty, off-beat humor.
Initially Frankie accepted the frame without any resistance to it. As the analysis progressed, he began to identify with me as an artist and started selling his artwork. Eventually he began to gently push and pull on the frame with humble requests for changes in appointment times to accommodate the sale of his artwork. The requests seemed reasonable since he was one step away from homelessness and he desperately needed the money. I took pleasure in witnessing his newfound desire to romp around a larger bull ring with his newly developed libidinal life force, and I bent the frame to accommodate his needs when I could work it out with my own schedule.
After he terminated his twice weekly analysis with me, he would drop by occasionally to ask me for a “few minutes of my time”. I was happy to see him and hoped that he would ask me if he could resume his analysis, but he never did. Each time I felt disappointed. He would stand at the threshold of my office with one foot in the door and the other one out. He always talked with me while he was standing up, even though I invited him to sit down. Mostly he talked about what was going on at the artists’ cooperative, his art, or news about his trips and his daughter. After he was asked to join the board of the artists’ cooperative, he came by in his self-appointed role as ambassador and recruiter to encourage me and other veterans to join. My fantasy was that he wanted me to join him on his terms and on his territory so that he could maintain his fantasy of omnipotent magical control over the object. He asked me if I would write a letter, as he put it, “in your official VA capacity” to obtain grant money for the artists’ cooperative, since several veterans had now joined it. It was on one of these visits in January 2011, that I was identified as “Lucy”, the psychoanalytic matador, based on “Lucy”, the character in “I Love Lucy”. I can see myself as Lucy as I resemble her physically and characterologically. I was the blonde ditzy, hysterical, curious kitten.
Although Lucy pretended she was not afraid, she dangled her little red psychoanalytic cape ever so gingerly – just enough to get the bull’s attention and to allow “Ferdinand the Bull” to charge at it playfully so that he could safely project his deadly substances into it. The analysis became a safe intercourse in which he could discharge his aggression. I had seen with my own eyes how Frankie could switch from his endearing self to his raging self in an instant. I knew the kind of destruction he was capable of, if I made one wrong move. One death charge from Frankie the Bull, and Lucy and her red cape would be splattered about the ring with the rest of its tattered creative contents. At the depths of his existence was Thanatos, his “Killer Self”, saturated with excess death drive, primordial anxiety, envy, greed, aggression, boredom, loneliness, and emptiness.
I enjoyed going into the bullring. Of course this was no ordinary bullring. It looked like a creative war zone with art products scattered everywhere. A cluttered desk, equipped with a large screen computer anchored us in reality. A comfy chair on wheels allowed the bull to position himself at a comfortable distance from the matador.
We were joined in primary process and for a large part of the treatment I managed to perceive “Frankie the Bull” as an endearing little bull-et, or as the famous storybook character, “Ferdinand the Bull”. I had difficulty seeing “Frankie the Bull” as the bully he truly was. I identified with his embittered victim introject, which he continuously projected into me. Both of us split off from the “Italian Bull”, Frankie’s phallic breast mother introject. Neither of us wanted her savage and suffocating breast in the room. His idealization of me protected me from its mental corollary; his hatred and unconscious destructive impulses. Frankie’s transference was deeply split, as I was also the stand-in representation for his all-powerful Italian Bull Breast. He always spoke about his mother with deep hatred and resentment and frequently told me that he refuses to visit her grave. My counter-transference was split. I enjoyed the gratification of Frankie’s idealization of me and I split off the hated, greedy, withholding, denigrated, despised and aggressive pieces of both of us. As I gained more insight about the split off annihilating pieces of Frankie and myself, I went from idealizing to devaluing him, before a more realistic picture began to emerge towards the end of treatment.
His well-polished mix of smoke and mirrors and over-the-top humorous antics disarmed me, erasing my memories of his unexpected deadly attacks. When we were in the magic bullring together he was dear little Ferdinand with flowers entwined around his baby horns.
HOW TREATMENT BEGAN:
After several months of working with Frankie in group, I offered to work with him as my control case. I explained to him that I was a psychoanalytic candidate at a psychoanalytic institute and I asked him if he was interested in seeing me for twice-weekly individual therapy. I laid out the conditions of the therapy and explained that I needed to work with a patient who was able to commit to being in twice weekly therapy for at least one year; that I would be supervised by a training analyst from my psychoanalytic institute; that we would need to meet when I was in a non-pay status and no fee was involved. He asked appropriate questions about vacations and missed sessions. He was given the choice of seeing me at the Institute’s office or my office at the VA and he chose the VA because it was “more familiar” to him. It was intuitively evident to me that the only way of working with him was face to face as Frankie had demonstrated his distrust and paranoia on numerous occasions. He had mentioned before how he hated talking on the phone because he cannot see the person’s face. I did not explore why he needs to see the person’s face, I just accepted his basic need to keep me in sight. Frankie appeared to have no resistance to the new plan and was eager to begin treatment with me.
Frankie began therapy by telling me about his most recent depression. It was so severe that he could no longer force himself out of his apartment for days at a time. He stopped showing up for work at the car service where he had worked as a driver for the past fifteen years; was seven months in arrears on his rent; and he could no longer forage for junk food that he and his son were subsisting on. When his disintegration anxiety evoked thoughts of suicide and he was about to become homeless, he called his daughter who lived 3000 miles away to help him get hospitalized.
Frankie was a 60 year-old, divorced, first-generation Italian American Vietnam veteran, and was estranged from all his family, other than his daughter, whom he absolutely adored and idealized. She was his best friend and she could do no wrong. Although he and his son lived together in a one-bedroom apartment, they did not speak for months at a time and occasionally each threatened to call the cops when physical altercations occurred. Frankie’s son could do no right and was devalued and demonized. Frankie was completely estranged from his three older siblings whom he had not spoken to for years. He did not have any relationships to speak of other than his recent acquaintances at the VA and the “Mob-owned” car service where he drove seven days a week, taking overtime and every holiday to fill the void of loneliness and emptiness which enveloped him.
Frankie had not had a relationship with a woman, sexual or otherwise, for over sixteen years. He told me he left his drug and alcohol addicted girlfriend in order to achieve what is now his sixteen years of sobriety. He said that from the time he left Vietnam until he left his girlfriend, “I was always stoned on something – I did every kind of drug except for heroin until I quit cold turkey.” He maintained a split between sex and intimacy. Throughout his twenty years of marriage he continued to have sex with prostitutes, but when his wife finally took a lover, he felt betrayed, and so he divorced her. Throughout his tour in Vietnam he only had sex when he went to Thailand. My fantasy about this is that he would not sleep with the enemy. He had shared this piece of information early on in his analysis and in retrospect I wish I would have explored this with him. I consider this one of those missed opportunities due to a lack of experience as a beginning analyst. I held back because I feared that he might experience my inquiry about this as intrusive.
For the first four months of treatment Frankie was always prompt and never missed a session. He was compliant with maintaining the frame inside the session time, and he was acting out as if he were the law outside the session time as he often described vignettes which depicted his assaultive behavior towards anyone who offended him. He mostly talked about his life outside the session time – about his frequent verbal and physical altercations with strangers or anyone who did not agree with him or his views. Frankie felt he was always right in serving justice in this way. Initially he acted out his need for omnipotent control outside the analytic hours, but as the transference developed and I became less idealized, he shifted to acting in during the analytic hours.. He went from acting out to acting in mostly around the analytic frame. Towards the end of treatment he went about destroying the analytic frame altogether with missed appointments and not bothering to call me to reschedule or to let me know why he missed his appointments.He used therapy to reflect on his assaultive and aggressive behavior and modified his aggressive impulses outside the analytic hours so that he eventually was able to work within society’s systems.
Frankie identified with me as an artist and after several months of analysis he began to paint all day and into the wee hours of the night. He discovered that his newfound creativity helped him sleep better so he did not have to “pop all that toxic sleep medication” that he finally flushed down the toilet. It also gave him a respite from those two haunting nightmares: “Being chased on a path”; and “looking down on a circle of Asians from above”. He was not able to articulate what his art or dreams symbolized and was highly resistant to “exploring their meaning” with me.
Ferdinand the Bull discovered that he enjoyed selling his paintings in a city park where artists and performers gathered daily to sell their wares. Later he developed enough artistic confidence to join a local artists’ cooperative. The park and the artists’ cooperative became his newly created families and provided him with support apart from Lucy, the psychoanalytic matador, on whom he did not want to become too dependent. The money he made from selling his art kept food on the table and obviated homelessness while he awaited approval for his disability benefits from VA. He charmed his fans and customers with his amusing stories and comic antics that enhanced the marketing of his artwork (Frankie had abandoned his education over 30 years ago when he was just a few courses short of a Bachelors Degree in Marketing).
Suddenly one day, his beloved park turned on him, and as he put it, “lost its tranquility.” His park with its flowing milk turned toxic in an instant and became the persecuting “Italian Bull Breast.” This happened when a city cop threatened, as he put it, “To give a Vietnam War Veteran a ticket on Memorial Day Weekend, just because his art was displayed on a three-legged illegal table.” I wholeheartedly empathized with Frankie’s victim introject. After this humiliating experience, Frankie could not bring himself to return to the park until a year later. He blamed his delayed return on the carpenter he had hired to construct a new display table. Now his sessions were flooded by the persecuting carpenter, who was the new phallic Bull Breast, which was keeping all the milk for itself, by not completing his table. Several months later, Frankie stopped by his tailor for the third time pick up his blazer he had dropped off to have the sleeves shortened, and when the tailor told him it was not ready, Frankie went into a rage and threatened to cut off the tailor’s arms. Now the tailor had become the persecuting Italian Bull Breast. He displaced the rage he felt towards the Italian Bull Breast onto the cop, carpenter and tailor who were all stand-ins for it.
As therapy progressed Frankie brought in more of his Vietnam War self and survivor’s guilt into the room. He talked about the death of his replacement with deep sadness and guilt. He spoke about how “every day was Father’s Day and that he cries himself to sleep wondering about how many children he left fatherless and unborn in Vietnam because of his killing.” He countered this with stories about his own greatness as a father to his own children. Frankie prided himself on dispelling all their childhood myths so that they would be prepared for the real truth about life. Santa Claus was not real.
Frankie knew he was in his early sixties but not sure exactly how old he was or the ages or birth-dates of his son and daughter, who were now adult children in their late-twenties-early thirties. He had to ask his daughter for this information. He described his daughter as his “best friend”, and for many years, she has served as an alternative ego for him.
Frankie referred to his mother as the “Italian Bull”. He was not sure how old she was when she gave birth to him. He told me, “She had me very late in life, after she had a back alley abortion with the pregnancy before she became pregnant with me”. His mother could not speak English and he could not speak Italian. My reverie about why he never learned to speak Italian is that he could not take in his “mother tongue” as it became a symbol of his mother’s toxic milk. The Italian language itself was experienced as a bad breast in the same way that the Asian language was experienced as a bad breast. Frankie was the youngest of four children. His oldest sister and brother were both adults when he was born and his sister “closest to him” was a teenager.
Frankie recalled a few of his childhood memories: His mother taking him to Coney Island to purchase the bamboo canes she used to beat him with; and her bashing his head into the window casing so hard she gave him a concussion; hiding under the kitchen table when his brother and father threw punches and furniture at each other, as his mother stood by and screamed in Italian; and waving good-bye to his parents on the pier as they left for Italy, where his father suddenly died. Frankie described his father as passive and not protecting him from the “Italian Bull”. His childhood provided sadistic grooming and anticipation of fear when relating with others.
Memories of Vietnam include: his savage checkpoint behavior – poking his fingers into their eyes, dragging them out and bashing their head repeatedly into the vehicle; witnessing an interrogation and torture of a prisoner whose head was bashed with a gun so many times that his brains spilled out; watching his commander shoot a teenage girl whose chest had been half blown off by helicopter fire; and getting wounded.
His father’s funeral was the most devastating trauma of his life. Frankie hated his mother for hosting such an extravagant funeral in Italy, which, as he put it, “drove the family into debt and robbed me of my childhood. It forced me to work summers and after school just to pay down the family debt”. He brought in his father’s funeral album to show me the evidence. He confided, “Ordinarily I would not show this to anyone outside the family, but I wanted you to see this because of the special relationship we have”. Frankie pointed to the photo of his mother leaning over his father’s corpse on his deathbed to give him her final farewell kiss of death. He cynically exclaimed, “After that one shot, she never appears in any of the other photos. She never even attended the funeral or the burial. It was all for the camera”. Klein (1975 a) noted:
The fear of being devoured by the father derives from the projection of the infant’s impulses to devour his objects. In this way, first the mother’s breast (and the mother) becomes in the infant’s mind a devouring object and these fears soon extend to the father’s penis and to the father. At the same time, since devouring implies from the beginning the internalization of the devoured object, the ego is felt to contain devoured and devouring objects. Thus the super-ego is built up from the devouring breast (mother) to which is added the devouring penis (father). These cruel and dangerous internal figures become the representatives of the death instinct…The fear of being annihilated includes the anxiety lest the internal good breast be destroyed, for the object is felt to be indispensable for the preservation of life. The threat to the self from the death instinct working within is bound up with the dangers apprehended from the internalized devouring mother and father, and amounts to fear of death. (p. 30)
Now Frankie devoted his sessions to comparing the way bodies were disposed of in Vietnam with the way his father’s body was “wastefully disposed of.” He told me, “Over there, bodies were bagged or thrown into mass graves or just left to rot. There was no respect for death”. His father’s corpse was paraded around in a glass carriage drawn by a team of black horses adorned with black feather head-plumes, followed by a procession of two hundred paid mourners. Frankie asked me several times if I wanted to purchase his cemetery plots that he had purchased for himself and his ex-wife upon his return from Vietnam. His implied death wishes left me speechless. I felt assaulted by Frankie’s ideation about my own death and it frightened me. Underneath his idealizing transference, I experienced myself condensed with his hated mother and his ex-wife, both of whom he very much wanted to kill. Now that I have more experience and confidence in my analytic skills and the analytic process, I might have said, if I were to use that grave, how might I die? Or if I died before you would you visit my grave?
Frankie’s phantasies about his father’s funeral is a re-transcription of his phantasies as an infant when he imagined that his phallic Italian Bull Breast had devoured and incorporated his father’s penis inside itself. These phantasies were fueled by his excessive envy and oedipal jealousy towards both parents. As Klein (1975 a) suggests,
The development of the Oedipus complex is strongly influenced by the vicissitudes of the first exclusive relation with the mother, and when this relation is disturbed too soon, the rivalry with the father enters prematurely. Phantasies of the penis inside the mother, or inside her breast, turn the father into a hostile intruder. This phantasy is particularly strong when the infant has not had the full enjoyment and happiness that the early relation to the mother can afford him and has not taken in the first good object with some security. Such failure partly depends on the strength of envy…The influence of the combined parent figure on the infant’s ability to differentiate between the parents, and to establish good relations with each of them is affected by the strength of envy and the intensity of his oedipal jealousy. For the suspicion that the parents are always getting sexual gratification from one another reinforces the phantasy–derived from various sources-that they are always combined. If these anxieties are strongly operative, and therefore unduly prolonged, the consequence may be a lasting disturbance in relation to both parents. In very ill individuals, the inability to disentangle the relation to the father from the one to the mother, because of their being inextricably interlinked in the patient’s mind, plays an important role in severe states of confusion. (p. 197-198)
Frankie’s projection of his cannibalistic attacks on his Italian Bull Breast and fears of its retaliation were exacerbated by his mother’s hostility and death wishes towards him. His hatred towards his mother, “The Italian Bull” extended to his relationship with his father and all other object relations as well.
Klein (1975 a) writes:
The flight from the mother to other people, who are admired and idealized in order to avoid hostile feelings towards that most important envied (and therefore hated) object, the breast, becomes a means of preserving the breast-which means also preserving the mother…The way in which the turning from the first to the second object, the father, is carried out is of major importance. If envy and hatred are predominate, these emotions are to some degree transferred to the father or to siblings, and later to other people, and thereafter the flight mechanism fails. (p. 217)
Frankie experienced his father as abandoning whereas his mother was always raging, annihilating, devouring and suffocating. That male/female Italian Bull Breast that greedily kept all of Frankie’s milk for itself was now symbolized by his father’s funeral and funeral album. This vicious projective and introjective cycle of his death instinct increased his hatred, greed, and envy, and left him feeling depleted and in a paranoid state. The combination of his mother’s abusive behavior and lack of nurturing; the traumatic loss of his father at a young age; his financial deprivation and the Vietnam War prevented him from building up enough libido or life instinct to develop his ego and stifled his capacity for love and gratitude. He never was able to develop basic trust. From the day he was born until now, his external “facilitating environment” was lacking, violent and hostile.
Winnicott (1989) writes:
In the area of psychoneurosis it is castration anxiety that lies behind the defenses, in more psychotic phenomena that we are examining it is a breakdown of the establishment of the unit self that is indicated. The ego organizes defenses against breakdown of the ego organization, and it is the ego-organization that is threatened. But the ego cannot organize against environmental failure in so far as dependence is a living fact…
The individual inherits a maturational process. This carries the individual along in so far as there exists a facilitating environment, and only in so far as this exists. The facilitating environment is itself a complex phenomenon and needs special study in its own right; the essential feature is that it has a kind of growth of its own, being adapted to the changing needs of the growing individual…The facilitating environment can be described as holding, developing into handling, to which is added object-presenting. In such a facilitating environment the individual undergoes development which can be classified as integrating, to which is added indwelling (or psycho-somatic collusion) and then object-relating. (p. 88-89)
Six months into treatment Frankie discovered a donation cadaver program at a local university. His cadaver contract and the disposal of his remains became a major focus. He enjoyed entertaining me with his morbid jokes, which served as a defense against his unconscious painful and anxious feelings; and I enjoyed the jokes as they protected me from my own fear and anxiety about death. His self-hatred and denigration was revealed when he told me that his body was of more value to society dead than alive, and as he put it, “At least then it will be put to good use – for scientific research rather than for killing.” By donating his body to the cadaver program he is making reparation for his existential guilt for all his killing. Frankie talked about all the benefits of the cadaver program. “They pick up the body and dispose of all the unused parts for free! This way the family doesn’t have to squabble over the debt”. He asked his daughter if she wanted to keep his skeleton as a conversation piece. Even in death he fantasized that he could remain with his daughter. His excitement about the cadaver program was at such a peak that I imagined that he was trying to sell me on buying into the cadaver program. In my reverie about this I wondered if he wanted us to be joined in death. I imagined that he might be fantasizing that we could be dissected together and that our unused body parts could be thrown together in a garbage heap for eternity. He joked, “I told my daughter to make sure to dress up my stiff and put me on a plane and have the cadaver program meet the body at the airport. They only pick up the body for free if you die in the state.” Against his daughter’s wishes, he arranged to leave everything to her and nothing to his son. When his kids were little, he told them, “If I should die, just put me out on the curb with the rest of the garbage.”
Frankie hated the government and the media and he was very bitter about being drafted. He often wondered out loud, “If the army knew I was a killer.” He resented his mother for trying to stop his deployment to Vietnam, as it only delayed his deployment and resulted in his assignment to “funeral detail.” This was truly hell on earth as he had to assist with the funerals and burials of deceased soldiers killed in Vietnam. He wondered how his family would feel if he was in the box. When he got his orders for Vietnam, he refused to do any more funeral detail and suggested they put him in the brig instead.
When Frankie returned from Vietnam, he moved back into his mother’s house, where she continued to treat him as a child, and not as a man who had returned from war. She suffocated him with her screaming and insisted he be home by 10:30 PM. He exclaimed, “I told her at that time in Vietnam I was killing someone or that they were trying to kill me.” After he almost strangled her twice, he moved out. He employed a massive reaction formation defense against being like his mother, yet he is just like how he described her – explosive and assaultive.
Frankie’s immense masochism and guilt is demonstrated by the fact that he currently lives in a neighborhood with a lot of Asians. Memories of Vietnam are triggered by seeing Asians, particularly if they look at him in a certain way or when he smells their cooking. To avoid becoming assaultive, he has to exit a bus or train when he hears Asians speaking. He exclaims, “It’s the cadence of their voice that bothers me.” The cadence of their voice not only triggers memories of Vietnam, it may also trigger unconscious traumatic phantasies of his infancy and childhood of his mother’s screaming at him in a language he could not understand.
Awakening of Libido
About five months into his analysis, Frankie began to actively experience libidinal strivings, and therefore began to allow himself access to his sexuality. He embarked on a new relationship with an “on-line” girlfriend. He told me that his new girlfriend sent him a “hot and steamy e-mail”. When I asked him about what was in it, I became the phallic Bull Breast. With a dead serious look in his eyes, and in a cutting tone, he asked, “What are you lacking”? In that hazardous moment, Frankie the Bull no longer saw me as Lucy, the playful matador. For him, it appeared that I lost the maternal gleam in my eyes. At that moment he phantasized that I had turned into a giant devouring, castrating, and vagina Bull Breast. He left me frightened and speechless, as I raced through my own thoughts and feelings of how I was lacking. Perhaps if I had more confidence in my analytic skills and technique, I could have explored with him how it made him feel to think of me as lacking. In retrospect I could have worked more with the relationship, but at that point in time, I did not have enough trust in my analytic expertise and I was too frightened. My instincts prevented me from engaging with him at this level of relatedness. What happened between us around the “hot and steamy e-mail” captures the essence of the transference and countertransference manifestations between us. Neither of us were developed enough to deal with unleashing “The Annihilating Black Square of Thanatos” into the bullring. In that moment of my inquiry into the hot and steamy e-mail, Frankie projected his sexual impotence into me, which I introjected and reflected back to him, leaving us both “lacking”. Now his “I Love Lucy Breast” had become the Italian Bull Breast that was lacking – an impotent scooped out phallus with no milk. Mother and all women are experienced as castrating and devouring. The Italian Bull has no breast, it only has a phallus. It has no milk and no nurturing capacity. His phallic breast is too confusing, demanding and unpredictable. It embodies persecuting annihilating aggression. I needed the master matador, my supervisor, to help me realize that he had projected his own sexual impotence into me. Both of us were now that impotent scooped out Breast face to face in the bullring. Again I asked him about what was in the hot and steamy e-mail, and so he told me: “I imagine myself taking a sip of scotch from my glass and as I lean over to kiss you, a drop of alcohol drops from my lips onto yours”. I avoided the sexually laden erotic transference implications of his comment and asked him how this e-mail impacted on him. He laughed as he replied, “She got me all worked up – I was so horny I couldn’t sleep for the rest of the night”. I asked him if he thought this fantasy might impact adversely on his sobriety. He minimized its malignant impact and said, “Oh, that doesn’t bother me”.
In the ensuing sessions Frankie took delight in entertaining me with the romantic details of their courtship, such as when his girlfriend told him about purchasing a little red negligee for their first night together; and how he brought the candles and music for the hotel room. When they finally did have intercourse, he complained, “It took me hours to ejaculate.” Frankie’s castration anxiety was the result of his unconscious phantasies as an infant, when he imagined he had destroyed his good breast by tearing it to bits with his excessive greed and envy. Now he feared his breast would retaliate by castrating and devouring him. Sexual intercourse with his girlfriend evoked these infant phantasies, which now caused his difficulties in releasing his sexual products. Frankie phantasized that he had contaminated her good breast by projecting his own oral, anal and urethral products into it.
Klein (1975a) claimed:
The capacity for full oral gratification, which is rooted in a satisfactory relation to the mother, is the basis for experiencing full genital orgas (Freud). In men, the envy of the mother’s breast is also a very important factor. If it is strong and oral gratification thereby impaired, hatred and anxieties are transferred to the vagina. Whereas normally the genital development enables the boy to retain his mother as a love-object, a deep disturbance in the oral relation opens the way for severe difficulties in the genital attitude towards women. The consequence of a disturbed relation first to the breast and then to the vagina are manifold, such as impairment of genital potency, compulsive need for genital gratification, promiscuity, and homosexuality. (p. 201a)
The relationship with his girlfriend is a representation of his phantasized relationship with me and my idealized “I Love Lucy Breast”. All went well with his girlfriend until he began to notice that she no longer thought exactly as he did or could not do everything he wanted to do. Her increased demands for sex and intimacy suffocated him, and he had to flee from her. He could not tolerate being with her or me, when we ceased to just gratify his needs and hold his idealized projections.
Once Frankie had referred to his ex-wife as “A good looking horse”, so I asked him, what kind of barnyard animal is your new girlfriend? He laughed and said, “She’s a rooster”. When I asked him why she was a rooster, he replied, “Because her hair is dark with one orange strip down the middle.” As his analysis with me and his relationship with his girlfriend continued, Frankie introjected more nurturing, gratifying, female breasts creating more available libido and ego. His “Rooster Breast” was gradually transformed from a phallic male image into a female representation as he began to refer to his girlfriend as a cow. His transformation of the Italian Bull Breast into the Rooster Breast; and then into the “Cow Breast, represents a gradual transition in his object relations. The all powerful phallic Italian Bull Breast representation is diminished in size and is less destructive as it is transformed into the male Rooster Breast.
The vicissitudes of Frankie’s bestiary of symbolization can be summarized thusly: as Frankie’s relationship with his girlfriend and their courtship developed, and his sexual fantasies increased, he transformed his “Rooster Breast” into an idealized “Cow Breast”- a large nourishing female representation with an abundance of milk. After they had sexual intercourse it began to turn toxic and contaminated as he projected more of his own toxic substances into it. Frankie’s girlfriend and I were all the barnyard animals and the I Love Lucy Breast but he did not know it. As these female breasts became more developed, female, and differentiated, he experienced them as more demanding, suffocating and devouring. They turned on him, like all the other barnyard animal breasts had done before. The transformations of his barnyard animals reflect the gradual modifications in Frankie’s self and object representations as his analysis progressed. At first we see a gradual softening and modification of his object representations and relations; and how Thanatos is diminished as the result of his increased libido from introjecting idealized “needs gratifying” breasts. When I asked him why his girlfriend turned from a rooster into a cow, he laughed and replied, “Because she’s overweight.” When I asked him, “What kind of a barnyard animal am I? He spontaneously replied, “You’re a cat.” I asked him why I was a cat and he said, “Because cats are curious and intelligent.” He quickly told me, “I only like dark women.” This is opposite to me. I am fair with blue eyes and blonde hair. I asked him why he only likes dark women and he said, “Because they are sexually less inhibited; more direct, more sensual and easier to relate to.”
Frankie projected his sexual inhibitions and his unconscious split in his sexuality into me. He is not able to tolerate seeing Lucy, his maternal breast, as a sexual breast. His self-state in the transference was so young that I did not experience him as a sexual object. We were both much younger part objects. At that point in Frankie’s analysis, and my development as an analyst, we had to be. I did not address his transference to me as a sexually inhibited woman because I felt it was too dangerous to be in the bullring with Frankie the Bull as a giant sexual, castrating vagina Breast.
Although the vignettes he shared about Vietnam were tragic and deadly, Frankie talked about them with bravado and humor. When we touched on his feelings of existential guilt and sadness, he quickly placed us dead center in a MASH episode. He was a gifted storyteller and it felt like we there “in country” sharing and reliving all his extraordinary existential moments together. He laughed as he told me, “I volunteered to Walk Point (the most forward and dangerous position) in my unit.” I asked why he volunteered for the most dangerous position, and he replied, “Because I was a little guy and I couldn’t carry all that heavy equipment and ammo in that 120 degree heat.” My fantasy about this is that consciously he volunteered to Walk Point because he did not trust his life with anyone else in that position (Frankie’s need for omnipotent control was established very early in life) but unconsciously it was an expression of his Death Wish. He spoke about his guilt about the death of his replacement, which he had trained, with sadness in his voice. Two weeks before Frankie left Vietnam, his replacement stepped on a mine, lost both his legs and died several days later. When Frankie began to feel his unbearable guilt and depressive anxiety, he fled further into his “paranoid-schizoid” defenses of omnipotence, splitting and denial.
Frankie confided in me, “Some veterans enjoyed the killing,” and I replied, “Yes, some vets do.” This allowed him to bring his killer self into the room. Soon after this, he brought in one of his poems entitled, “First Kill”, which begins, “Who died that night, was it him or was it me?” He then told me about a painting he had hanging on his wall that haunted him, entitled, “Blood on the Leaves”.
The painting was a primitively rendered image of an American and a Viet Cong soldier, both peering out from bloodied leaves. He told me, “The American soldier and the enemy were just the same, only one had a helmet and the other had slanted eyes. Other than that they were just the same.” For Frankie, there was very little differentiation between him and the enemy, or between him and me, or between him and anyone else for that matter. We were all the persecuting Italian Bull Breast and we could annihilate each other at any moment. He wanted me to keep the painting in my office, so I did.
Frankie only brought in two recurring dreams throughout his analysis. Both dreams represent traumas in infancy and childhood. In one dream he is being chased on a path. He connects this dream with an incident in Vietnam, when he chased down the enemy after an ambush, shot him in the back, and then discovered that he was lost and separated from his unit. Getting lost and separated from his unit in Vietnam evoked his earlier phantasies of separation and annihilation anxiety from the trauma of his own birth. His Italian Bull Breast, the military, and the Vietnam War, were all violent and deadly environments which exacerbated his primordial anxiety. Being dependent on such a hostile and violent breast must have produced unfathomable amounts of primordial anxiety, but without it there was nothing.
In his other dream, Frankie is “up above looking down on a circle of Asians.” This dream represents his original dissociative splitting defenses – out of body phantasies he employed as an infant to protect his self from his Italian Bull Breast. The Asians represent his Italian Bull Breast in bits and pieces that he looks down on from above who are going to turn around and attack him from every direction. His projections and re-introjections of his raging attacks on it (the Asians/his Italian Bull Breast) weaken his ego, and flood him with disintegration anxiety. Frankie’s inner and outer world is in bits and pieces. He is always being attacked from within by his own unconscious phantasies and from without by his predominately hostile, violent, rejecting and abandoning environment.
Good Breast vs. Bull Breast
To Frankie, I was a curious and intelligent two-dimensional TV character and a neutered cat/kitten. Perhaps his relationship with me may be the highest level of relatedness to a female breast or to anyone he has ever had. As I learned more about Frankie’s traumatic childhood, and his life of trauma and failures, I came to understand through supervision, that Frankie the soldier may have been his highest level of functioning; and that the military may have been the best Breast he had ever had until he found mine.
Frankie the Bull-et must have wondered if his Thanatos Breast was a breast or a penis or if it was both. It must have been very confusing. In order to survive on that empty phallic breast he had to resort to cannibalism, as he sucked and scooped it out, along with the rest of the “Italian Bull’s” body. He must have believed himself to be a Thanatos baby and that he had created that Italian Bull Breast with his own omnipotent demonic powers. Who knows what Frankie’s pre-natal life was like?
Klein (1975 b) believed:
In the oral-sadistic stage which follows upon the oral-sucking one, the small child goes through a cannibalistic phase with which are associated a wealth of cannibalistic phantasies. These phantasies, although they are still centered on eating up the mother’s breast or her whole person, are not solely concerned with the gratification of a primitive desire for nourishment. They also serve to gratify the child’s destructive impulses. The sadistic phase which succeeds this – the anal sadistic phase – is characterized by a dominating interest in excretory processes – in feces and the anus; and this interest, too, is closely allied to extremely strong destructive tendencies…between the oral-sadistic and anal sadistic stages there exists another stage in which urethral-sadistic tendencies make themselves felt, and that the anal and urethral tendencies are a direct continuation of the oral sadistic ones as regards the specific aim and object of attack. In its oral-sadistic phantasies the child attacks its mother’s breast, and the means it employs are its teeth and jaws. In its urethral and anal phantasies it seeks to destroy the inside of the mother’s body, and uses its urine and faeces for this purpose. In this second group of phantasies the excrements are regarded as burning and corroding substances, wild animals, weapons of all kinds, etc.; and the child enters a phase in which it directs every instrument of its sadism to the purpose of destroying its mother’s body and what is contained in it. (p. 253 b)
After Frankie had projected enough of his death instinct into his “I Love Lucy Breast”, it too became toxic like all the other barnyard breasts before it, poisoned by his own excrement and death wishes. It became too demanding and suffocating. Thanatos always overpowered Eros. Frankie never knew when that breast would turn on him. Frankie never had a “good enough” breast before.
A Good Object
For months Frankie talked about wanting to get rid of his son. When he finally drove him out by tearing up the apartment, he adopted “Oscar”, a male kitten. He told me, “I had to adopt Oscar when I noticed him in the litter trying to lick his birth-defected sister back to health.” Frankie replaced his son with Oscar, a diminished male Eros representation that he could now project his idealized self into. Frankie also identified with the sick kitten that Oscar tried to lick back to life.
Approximately nine months after he had fled treatment and “abandoned” me, he returned to the psychosocial program at the VA and revealed that he was feeling bored and lonely. He told me that he had adopted a female kitten a few months after he had adopted Oscar to keep Oscar company. I asked him what he named his female kitten and he told me that he named her Lucy . Frankie could tell me this, and bring in his more vulnerable self only after a significant amount of time had passed since he stopped his analysis. ”I asked him about Lucy, and Frankie replied, “I found Lucy in a boat (a vehicle that travels the unconscious waters) among an abandoned litter.” He laughed as he told me, “I named her Lucy, after Lucille Ball. Lucy was the first female star to have her own TV show. She was way before Oprah. I have fun with Lucy. She is curious and intelligent. Lucy likes to play throw and catch with me.” Frankie loves Lucy because she is playful and right where he wants all women to be – at his feet and ready to gratify him. Lucy, a neutered female kitten and younger mammalian self-object, replaced my “I Love Lucy Breast”.
As my analytic capacity increased and he became more dependent on my good breast, and as I became more real, his envy of me increased. As he approached the “depressive position”, his depressive anxiety and guilt overwhelmed him, precipitating his regression further into the paranoid-schizoid position. In the end, the barnyard animals had become much smaller and younger, representing Frankie’s flight into regression.
I asked Frankie jokingly, “So, who wears the pants in the family, you or the cats?” Frankie laughed and said, “They do – I’m always in my underwear and I’m always cleaning up after them.” Frankie invites me in to watch him play with his male and female kitten breasts in his underwear, but he does not want me to notice that his sexual apparatus does not work. Frankie is arrested very early in his psychosexual development. He is a 60 year-old man with childlike passions, the impulses and instincts of a very young child, who is expected to live his life as an adult man. Lucy the Kitty Breast appears to be a younger self-object who appears to be more oral than genital.
From the beginning I was a female object representation. Frankie is able to tolerate me being female but we do not know at what level of relatedness to female. Frankie’s mother, the “Italian Bull” remained an aggressive male representation, rather than even a phallic female representation. Frankie’s phantasies of his actual mother could not be transformed into a nurturing female representation. He enjoys playing with his Lucy Kitty/Pussy Breast and Oscar Penis Breast because they just gratify his needs, and this is all he can tolerate. The cat is a female representation but we do not know who this “pussy” is that he has taken home with him. Frankie had to leave me before I became toxic, devouring, suffocating and abandoning like all the other male/female breasts he has created and destroyed.
As Frankie drank in my mirroring of his idealized self; and introjected my good, libidinal, needs-gratifying breast, “The phallic Italian Bull Breast” was gradually transformed from male to female representations. Gradually the animals became tamer, smaller, more female and nurturing, less intimidating and domesticated.
Holding and Ego Development
I instinctively employed what Winnicott (1989), refers to as, a good enough holding or facilitating environment with primary maternal preoccupation.
I transformed my matador’s cape into a baby blanket, providing him with the warmth, nurturing and understanding he never had before. I held him gently and creatively for as long as he could tolerate it. Frankie took delight in the admiring gleam in my eye, as I enjoyed being part of his newly discovered creative enjoyment of life. My holding and his identification with me as an artist were the primary healing forces. Our joint humor and creativity served to keep Thanatos at bay; and to wake up Eros enough to transform the Minotaur into a slightly more integrated, flexible, and reflective individual who could join the human community, at least on its creative fringes. At least now “Ferdinand the Bull” could play with some of the other bohemians who also dance around the surface of human existence. He is more related and can now work marginally within the system when he has a personal grievance.
Winnicott, (1989) notes:
For babies there is a basic ration of “good breast” without which the early stages of the individual’s emotional development do not get initiated. Various authors have attempted to formulate this. Balint in his concept of primary love, myself in my terms “good enough mothering” and “primary maternal preoccupation”. The “good breast” proves to be a jargon term for (a) “good-enough mothering” and (b) “satisfactory feeding” and (c) the joining together of (a) and (b) first in the environment and then in the mind of the baby. (p. 453).
With just a taste of a “good enough” breast, Frankie developed enough libido to gradually modify his destructive impulses. As a result of his analysis with me, he re-connected with his family; traveled across the country to visit relatives and friends; expanded his psychosocial support system to include two artist’s communities; successfully obtained his 70% Service Connected Disability Pension from VA; paid off his back child support and other debts; obtained his American and Italian passports; attended his daughter’s wedding in Italy; opened a checking account and obviated homelessness. When Frankie left treatment he was able to work within society’s legal and financial systems.
End of Treatment:
Toward the end of treatment, when I decided to focus more on everyday reality as well as symbolic and unconscious process, and I gently questioned how his renewed use of marijuana would affect his treatment, the word treatment must have shattered his delusional transference. My sudden differentiation by my difference of thought about his marijuana use, and the word “treatment” shocked him. When I asked him if he wanted to continue treatment with me, it made him realize that his “I Love Lucy Breast” could suddenly be taken away. The momentary recognition of his own dependency needs and fears of abandonment; while simultaneously feeling suffocated by the relationship and the frame, led to his abrupt termination.
In this initial phase of Frankie’s treatment, I believe he would have fled much earlier if I had used even a “modified” or expressive approach of the sort suggested by Kernberg. I don’t think he could have tolerated a more active focus on our relationship by interpreting his defenses and underlying negative transference. In Kernberg’s (1985) review of the literature, he noted that Stone felt that patients with a borderline personality organization might need preparatory psychotherapy. (p. 76).
That authors dealing with the problem of the treatment of borderline conditions may be placed on a continuum ranging from those who recommend psychoanalysis, to those who believe that psychotherapy rather than psychoanalysis, and especially a supportive form of psychotherapy, is the treatment of choice”…in my opinion, in most patients presenting borderline personality organization a modified analytic procedure or special form of expressive psychoanalytic psychotherapy rather than classical psychoanalysis is indicated. This expressive approach should involve consistent interpretive work with those defensive operations reflecting the negative transference and contributing directly or indirectly to maintaining the patient’s ego weakness. (p. 75-77)
At this point in Frankie’s analysis, Frankie and I did not have the capacity for a modified or expressive approach. My analytic skills and technique were not developed enough, and Frankie had experienced too much trauma. He had never before had a supportive relationship. I believe a “holding” approach was a necessary “preparatory” phase of treatment before we could safely and successfully embark on a more expressive psychoanalytic psychotherapy approach. First he needed an experience of a supportive relationship, in contrast to his predominately traumatic relationships, to simply build capacity for being in a relationship at all. Frankie was psychically too young for a more interpretive approach.
Many factors contributed to my reticence about using more of my countertransference in session and working more directly with the transferential and actual therapeutic relationship. I had witnessed Frankie’s assaultive behavior and I imagined if he tried to strangle his mother twice, he might do the same thing to me. Other contraindications included his non-differentiated delusional idealized transference with its implied hatred and demonization of me. Interpreting Frankie’s negative transference was just too dangerous at that point in his analysis and my development as a psychoanalytic candidate in training. If Frankie’s ego and my analytic skills were more developed, maybe I could have shared more what it was like to sit with him.
In the end, Frankie walked into the bullring defeated. He shrugged his shoulders as he told me, “I am talked out.” I asked him if we could sit in silence together, and he laughed and said, “Well this would be okay if were both stoned and sitting on top of a mountain overlooking a beautiful landscape together.”
“Girl in the Garden Collage” here
As he parted (April 2009), Frankie gave me two little gifts of reparation – an appointment book and a collage that he had made of a young woman in a garden. The inner painting of the younga woman is framed by aprotective string perimeter Vietnam War veterans have been known to create perimeters as a measure of safety.Perhaps this represents an unconscious wish to protect me from his own aggression and negative transference.
In March 2011, Frankie physically assaulted his wife’s former lover of over 30 years ago in the VA cafeteria. He called me for a session. He cried. Perhaps this is a new beginning for Frankie and me. He drops by to say hi, but he has not resumed his analysis.
Frankie falls within the lower end of the borderline personality disorder spectrum with narcissistic features. In addition, he has an Axis I diagnoses of Post-traumatic Stress Disorder and Major Depression. Since Frankie’s abrupt termination of treatment in April of 2009, we both have grown. I have two more years of psychoanalytic experience and supervision under my belt and Frankie has returned with his more vulnerable self. I have developed more confidence in my psychoanalytic skills and technique and in the analytic process. The patient has developed more capacity and trust in his relationship with me. I feel both of us are ready for me to try a more expressive psychoanalytic approach.
Eigen, M. (1993). The Psychotic Core. Northvale, NJ: Jason Aronson Inc.
Kernberg, O. (1985). Borderline Conditions and Pathological Narcissism. Northvale, NJ: Jason Aronson Inc.
Klein, M. (1975 a). Envy and Gratitude And Other Works 1946-1963. Money-Kryle, R, Joseph, B. O’Shaughnessy, E, & Segal, H. Eds. New York, NY: The Free Press.
Klein, M. (1975 b). Love, Guilt and Reparation And other Works 1921-1945. Money-Kryle, R, Joseph, B. O’Shaughnessy, E, & Segal, H. Eds. New York, NY: The Free Press.
Winnicott, D., (1989). Psychoanalytic Explorations. Winnicott, C., Shepherd, R. & Davis, M., Eds. Cambridge, Massachusetts: Harvard University Press.
Melanie Zarabi, MPS, ATR-BC, LCAT, NCPsyA is a NAAP Certified Psychoanalyst and a Licensed, Board Certified, Creative Arts Therapist. She is a graduate of the Institute for Expressive Analysis; a graduate of Pratt Institute, with a Master of Professional Studies degree in Art Therapy and Creativity Development. She serves on the NAAP Board of Directors. Melanie has a private practice in NYC and is a painter and photographer.
Currently, Melanie is the Coordinator, Creative Arts Therapy and Clubhouse Programs at the VA New York Harbor Healthcare System. In 2008, she coordinated the First National Veterans Poster Project on the Afghanistan and Iraq War, sponsored by the National Office of Psychosocial Rehabilitation and Veterans Hospital Association. The original mural “Chaos of War-2008” is currently on exhibition at Deloitte.